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Vallée A, Quint R, Laure Brun A, Mellot F, Grenier PA. A deep learning-based algorithm improves radiology residents' diagnoses of acute pulmonary embolism on CT pulmonary angiograms. Eur J Radiol 2024; 171:111324. [PMID: 38241853 DOI: 10.1016/j.ejrad.2024.111324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/08/2023] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE To compare radiology residents' diagnostic performances to detect pulmonary emboli (PEs) on CT pulmonary angiographies (CTPAs) with deep-learning (DL)-based algorithm support and without. METHODS Fully anonymized CTPAs (n = 207) of patients suspected of having acute PE served as input for PE detection using a previously trained and validated DL-based algorithm. Three residents in their first three years of training, blinded to the index report and clinical history, read the CTPAs first without, and 2 months later with the help of artificial intelligence (AI) output, to diagnose PE as present, absent or indeterminate. We evaluated concordances and discordances with the consensus-reading results of two experts in chest imaging. RESULTS Because the AI algorithm failed to analyze 11 CTPAs, 196 CTPAs were analyzed; 31 (15.8 %) were PE-positive. Good-classification performance was higher for residents with AI-algorithm support than without (AUROCs: 0.958 [95 % CI: 0.921-0.979] vs. 0.894 [95 % CI: 0.850-0.931], p < 0.001, respectively). The main finding was the increased sensitivity of residents' diagnoses using the AI algorithm (92.5 % vs. 81.7 %, respectively). Concordance between residents (kappa: 0.77 [95 % CI: 0.76-0.78]; p < 0.001) improved with AI-algorithm use (kappa: 0.88 [95 % CI: 0.87-0.89]; p < 0.001). CONCLUSION The AI algorithm we used improved between-resident agreements to interpret CTPAs for suspected PE and, hence, their diagnostic performances.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Hôpital Foch. 40 rue Worth 92150 Suresnes, France.
| | - Raphaelle Quint
- Department of Medical Imaging, Hôpital Foch. 40 rue Worth 92150 Suresnes, France.
| | - Anne Laure Brun
- Department of Medical Imaging, Hôpital Foch. 40 rue Worth 92150 Suresnes, France.
| | - François Mellot
- Department of Medical Imaging, Hôpital Foch. 40 rue Worth 92150 Suresnes, France.
| | - Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch. 40 rue Worth 92150 Suresnes, France.
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Grenier PA, Brun AL, Mellot F. [The contribution of artificial intelligence (AI) subsequent to the processing of thoracic imaging]. Rev Mal Respir 2024; 41:110-126. [PMID: 38129269 DOI: 10.1016/j.rmr.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
The contribution of artificial intelligence (AI) to medical imaging is currently the object of widespread experimentation. The development of deep learning (DL) methods, particularly convolution neural networks (CNNs), has led to performance gains often superior to those achieved by conventional methods such as machine learning. Radiomics is an approach aimed at extracting quantitative data not accessible to the human eye from images expressing a disease. The data subsequently feed machine learning models and produce diagnostic or prognostic probabilities. As for the multiple applications of AI methods in thoracic imaging, they are undergoing evaluation. Chest radiography is a practically ideal field for the development of DL algorithms able to automatically interpret X-rays. Current algorithms can detect up to 14 different abnormalities present either in isolation or in combination. Chest CT is another area offering numerous AI applications. Various algorithms have been specifically formed and validated for the detection and characterization of pulmonary nodules and pulmonary embolism, as well as segmentation and quantitative analysis of the extent of diffuse lung diseases (emphysema, infectious pneumonias, interstitial lung disease). In addition, the analysis of medical images can be associated with clinical, biological, and functional data (multi-omics analysis), the objective being to construct predictive approaches regarding disease prognosis and response to treatment.
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Affiliation(s)
- P A Grenier
- Délégation à la recherche clinique et l'innovation, hôpital Foch, Suresnes, France.
| | - A L Brun
- Service de radiologie, hôpital Foch, Suresnes, France
| | - F Mellot
- Service de radiologie, hôpital Foch, Suresnes, France
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Grenier PA. COPD: artificial intelligence detects and quantifies anomalies on chest CT enabling prediction of disease severity. Eur Radiol 2024:10.1007/s00330-024-10601-1. [PMID: 38253906 DOI: 10.1007/s00330-024-10601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, France.
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Grenier PA, Brun AL, Longchampt E, Lipski M, Mellot F, Catherinot E. Primary immunodeficiency diseases of adults: a review of pulmonary complication imaging findings. Eur Radiol 2023:10.1007/s00330-023-10334-7. [PMID: 37935849 DOI: 10.1007/s00330-023-10334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/09/2023]
Abstract
Our objective in this review is to familiarize radiologists with the spectrum of initial and progressive CT manifestations of pulmonary complications observed in adult patients with primary immunodeficiency diseases, including primary antibody deficiency (PAD), hyper-IgE syndrome (HIES), and chronic granulomatous disease (CGD). In patients with PAD, recurrent pulmonary infections may lead to airway remodeling with bronchial wall-thickening, bronchiectasis, mucus-plugging, mosaic perfusion, and expiratory air-trapping. Interstitial lung disease associates pulmonary lymphoid hyperplasia, granulomatous inflammation, and organizing pneumonia and is called granulomatous-lymphocytic interstitial lung disease (GLILD). The CT features of GLILD are solid and semi-solid pulmonary nodules and areas of air space consolidation, reticular opacities, and lymphadenopathy. These features may overlap those of mucosa-associated lymphoid tissue (MALT) lymphoma, justifying biopsies. In patients with HIES, particularly the autosomal dominant type (Job syndrome), recurrent pyogenic infections lead to permanent lung damage. Secondary infections with aspergillus species develop in pre-existing pneumatocele and bronchiectasis areas, leading to chronic airway infection. The complete spectrum of CT pulmonary aspergillosis may be seen including aspergillomas, chronic cavitary pulmonary aspergillosis, allergic bronchopulmonary aspergillosis (ABPA)-like pattern, mixed pattern, and invasive. Patients with CGD present with recurrent bacterial and fungal infections leading to parenchymal scarring, traction bronchiectasis, cicatricial emphysema, airway remodeling, and mosaicism. Invasive aspergillosis, the major cause of mortality, manifests as single or multiple nodules, areas of airspace consolidation that may be complicated by abscess, empyema, or contiguous extension to the pleura or chest wall. CLINICAL RELEVANCE STATEMENT: Awareness of the imaging findings spectrum of pulmonary complications that can occur in adult patients with primary immunodeficiency diseases is important to minimize diagnostic delay and improve patient outcomes. KEY POINTS: • Unexplained bronchiectasis, associated or not with CT findings of obliterative bronchiolitis, should evoke a potential diagnosis of primary autoantibody deficiency. • The CT evidence of various patterns of aspergillosis developed in severe bronchiectasis or pneumatocele in a young adult characterizes the pulmonary complications of hyper-IgE syndrome. • In patients with chronic granulomatous disease, invasive aspergillosis is relatively frequent, often asymptomatic, and sometimes mimicking or associated with non-infectious inflammatory pulmonary lesions.
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Affiliation(s)
- Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, France.
| | | | | | | | | | - Emilie Catherinot
- Department of Pneumology, Hôpital Foch, Suresnes, France
- CEDITH (Centre de Référence Des Déficits Immunitaires Héréditaires), Hôpital Foch Affiliated to Versailles-Saint Quentin University, 40 Rue Worth, 92150, Suresnes, France
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Grenier PA. Cure Rate of Lung Cancer Diagnosed at Annual CT Screening. Radiology 2023; 309:e232698. [PMID: 37934092 DOI: 10.1148/radiol.232698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Philippe A Grenier
- From the Department of Clinical Research and Innovation, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France
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Grenier PA, Ayobi A, Quenet S, Tassy M, Marx M, Chow DS, Weinberg BD, Chang PD, Chaibi Y. Deep Learning-Based Algorithm for Automatic Detection of Pulmonary Embolism in Chest CT Angiograms. Diagnostics (Basel) 2023; 13:diagnostics13071324. [PMID: 37046542 PMCID: PMC10093638 DOI: 10.3390/diagnostics13071324] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Purpose: Since the prompt recognition of acute pulmonary embolism (PE) and the immediate initiation of treatment can significantly reduce the risk of death, we developed a deep learning (DL)-based application aimed to automatically detect PEs on chest computed tomography angiograms (CTAs) and alert radiologists for an urgent interpretation. Convolutional neural networks (CNNs) were used to design the application. The associated algorithm used a hybrid 3D/2D UNet topology. The training phase was performed on datasets adequately distributed in terms of vendors, patient age, slice thickness, and kVp. The objective of this study was to validate the performance of the algorithm in detecting suspected PEs on CTAs. Methods: The validation dataset included 387 anonymized real-world chest CTAs from multiple clinical sites (228 U.S. cities). The data were acquired on 41 different scanner models from five different scanner makers. The ground truth (presence or absence of PE on CTA images) was established by three independent U.S. board-certified radiologists. Results: The algorithm correctly identified 170 of 186 exams positive for PE (sensitivity 91.4% [95% CI: 86.4–95.0%]) and 184 of 201 exams negative for PE (specificity 91.5% [95% CI: 86.8–95.0%]), leading to an accuracy of 91.5%. False negative cases were either chronic PEs or PEs at the limit of subsegmental arteries and close to partial volume effect artifacts. Most of the false positive findings were due to contrast agent-related fluid artifacts, pulmonary veins, and lymph nodes. Conclusions: The DL-based algorithm has a high degree of diagnostic accuracy with balanced sensitivity and specificity for the detection of PE on CTAs.
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Affiliation(s)
- Philippe A. Grenier
- Department of Clinical Research and Innovation, Foch Hospital Suresnes, Versailles Saint Quentin University, 78000 Versailles, France
| | | | | | | | | | - Daniel S. Chow
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Brent D. Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Peter D. Chang
- Department of Radiological Sciences, University of California Irvine, Irvine, CA 92697, USA
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, CA 92697, USA
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Grenier PA, Brun AL, Mellot F. The Potential Role of Artificial Intelligence in Lung Cancer Screening Using Low-Dose Computed Tomography. Diagnostics (Basel) 2022; 12:diagnostics12102435. [PMID: 36292124 PMCID: PMC9601207 DOI: 10.3390/diagnostics12102435] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Two large randomized controlled trials of low-dose CT (LDCT)-based lung cancer screening (LCS) in high-risk smoker populations have shown a reduction in the number of lung cancer deaths in the screening group compared to a control group. Even if various countries are currently considering the implementation of LCS programs, recurring doubts and fears persist about the potentially high false positive rates, cost-effectiveness, and the availability of radiologists for scan interpretation. Artificial intelligence (AI) can potentially increase the efficiency of LCS. The objective of this article is to review the performances of AI algorithms developed for different tasks that make up the interpretation of LCS CT scans, and to estimate how these AI algorithms may be used as a second reader. Despite the reduction in lung cancer mortality due to LCS with LDCT, many smokers die of comorbid smoking-related diseases. The identification of CT features associated with these comorbidities could increase the value of screening with minimal impact on LCS programs. Because these smoking-related conditions are not systematically assessed in current LCS programs, AI can identify individuals with evidence of previously undiagnosed cardiovascular disease, emphysema or osteoporosis and offer an opportunity for treatment and prevention.
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Affiliation(s)
- Philippe A. Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, 92150 Suresnes, France
- Correspondence:
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Grenier PA. Deep Learning Assessment of Emphysema Progression at CT Predicts Outcomes. Radiology 2022; 304:680-682. [PMID: 35579529 DOI: 10.1148/radiol.220627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Philippe A Grenier
- From the Department of Clinical Research and Innovation, Hôpital Foch, 40 rue Worth, Suresnes 92150, France
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Grenier PA, Hoffman EA, Screaton N, Seo JB. BJR functional imaging of the lung special feature: introductory editorial. Br J Radiol 2022; 95:20229004. [PMID: 35312377 PMCID: PMC9153701 DOI: 10.1259/bjr.20229004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Eric A Hoffman
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Joon Beom Seo
- University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea
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Laporte A, Mariampillai K, Allenbach Y, Pasi N, Donciu V, Toledano D, Granger B, Benveniste O, Grenier PA, Boussouar S. Idiopathic inflammatory myopathies: CT characteristics of interstitial lung disease and their association(s) with myositis-specific autoantibodies. Eur Radiol 2022; 32:3480-3489. [PMID: 35022809 DOI: 10.1007/s00330-021-08411-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Interstitial lung disease (ILD), one of the most common extramuscular manifestations of idiopathic inflammatory myopathies (IIMs), carries a poor prognosis. Myositis-specific autoantibody (MSA)-positivity is a key finding for IIM diagnosis. We aimed to identify IIM-associated lung patterns, evaluate potential CT-ILD finding-MSA relationships, and assess intra- and interobserver reproducibility in a large IIM population. METHODS All consecutive IIM patients (2003-2019) were included. Two chest radiologists retrospectively assessed all chest CT scans. Multiple correspondence and hierarchical cluster analyses of CT findings identified and characterized ILD-patient subgroups. Classification and regression-tree analyses highlighted CT-scan variables predicting three patterns. Three independent radiologists read CT scans twice to assign patients according to CT-ILD-pattern clusters. RESULTS Among 257 IIM patients, 94 (36.6%) had ILDs; 87 (93%) of them were MSA-positive. ILD-IIM distribution was 54 (57%) ASyS, 21 (22%) DM, 15 (16%) IMNM, and 4 (4%) IBM. Cluster analysis identified three ILD-patient subgroups. Consolidation characterized cluster 1, with significantly (p < 0.05) more frequent anti-MDA5-autoantibody-positivity. Significantly more cluster-2 patients had a reticular pattern, without cysts and with few consolidations. All cluster-3 patients had cysts and anti-PL12 autoantibodies. Clusters 2 and 3 included significantly more ASyS patients. Intraobserver concordances to classify patients into those three clusters were good-to-excellent (Cohen κ 0.64-0.81), with good interobserver reliability (Fleiss's κ 0.56). CONCLUSION Despite the observed IIM heterogeneity, CT-scan criteria enabled ILD assignment to the three clusters, which were associated with MSAs. Radiologist identification of those clusters could facilitate diagnostic screening and therapeutics. Interstitial lung disease in patients with idiopathic inflammatory myopathy could be classified into three clusters according to CT-scan criteria, and these clusters were significantly associated with myositis-specific autoantibodies. KEY POINTS • Cluster analysis discerned three homogeneous groups of interstitial lung disease (ILD) for which cysts, consolidations, and reticular pattern were discriminatory, and associated with myositis-specific autoantibodies. • Like muscle- and extramuscular-specific phenotypes, myositis-specific autoantibodies are also associated with specific ILD patterns in patients with idiopathic inflammatory myopathies.
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Affiliation(s)
- Amandine Laporte
- Cardiovascular and Thoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University and Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
| | | | - Yves Allenbach
- MRSU 974, INSERM, Research Center in Myology, Sorbonne University, Paris, France.,Department of Internal Medecine and Clinical Immunology, Referral Center for Rare Neuromuscular Diseases, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Nicoletta Pasi
- Cardiovascular and Thoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University and Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
| | - Victoria Donciu
- Department of Radiology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Dan Toledano
- Cardiovascular and Thoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University and Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
| | - Benjamin Granger
- Department of Public Health (INSERM UMR 1136) and Pharmaco-Epidemiology Center, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Olivier Benveniste
- MRSU 974, INSERM, Research Center in Myology, Sorbonne University, Paris, France.,Department of Internal Medecine and Clinical Immunology, Referral Center for Rare Neuromuscular Diseases, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Philippe A Grenier
- Referral Center for Neuro-Muscular Diseases, DHUi2B, Paris and Department of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | - Samia Boussouar
- Cardiovascular and Thoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University and Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France.
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Willer K, Fingerle AA, Noichl W, De Marco F, Frank M, Urban T, Schick R, Gustschin A, Gleich B, Herzen J, Koehler T, Yaroshenko A, Pralow T, Zimmermann GS, Renger B, Sauter AP, Pfeiffer D, Makowski MR, Rummeny EJ, Grenier PA, Pfeiffer F. X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study. Lancet Digit Health 2021; 3:e733-e744. [PMID: 34711378 PMCID: PMC8565798 DOI: 10.1016/s2589-7500(21)00146-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although advanced medical imaging technologies give detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection of respiratory diseases and follow-ups is still lacking. The novel method of x-ray dark-field chest imaging might fill this gap but has not yet been studied in living humans. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest x-rays, and yet requires only a fraction of the dose applied in CT. We studied the application of this technique to assess pulmonary emphysema in patients with chronic obstructive pulmonary disease (COPD). METHODS In this diagnostic accuracy study, we designed and built a novel dark-field chest x-ray system (Technical University of Munich, Munich, Germany)-which is also capable of simultaneously acquiring a conventional thorax radiograph (7 s, 0·035 mSv effective dose). Patients who had undergone a medically indicated chest CT were recruited from the department of Radiology and Pneumology of our site (Klinikum rechts der Isar, Technical University of Munich, Munich, Germany). Patients with pulmonary pathologies, or conditions other than COPD, that might influence lung parenchyma were excluded. For patients with different disease stages of pulmonary emphysema, x-ray dark-field images and CT images were acquired and visually assessed by five readers. Pulmonary function tests (spirometry and body plethysmography) were performed for every patient and for a subgroup of patients the measurement of diffusion capacity was performed. Individual patient datasets were statistically evaluated using correlation testing, rank-based analysis of variance, and pair-wise post-hoc comparison. FINDINGS Between October, 2018 and December, 2019 we enrolled 77 patients. Compared with CT-based parameters (quantitative emphysema ρ=-0·27, p=0·089 and visual emphysema ρ=-0·45, p=0·0028), the dark-field signal (ρ=0·62, p<0·0001) yields a stronger correlation with lung diffusion capacity in the evaluated cohort. Emphysema assessment based on dark-field chest x-ray features yields consistent conclusions with findings from visual CT image interpretation and shows improved diagnostic performance than conventional clinical tests characterising emphysema. Pair-wise comparison of corresponding test parameters between adjacent visual emphysema severity groups (CT-based, reference standard) showed higher effect sizes. The mean effect size over the group comparisons (absent-trace, trace-mild, mild-moderate, and moderate-confluent or advanced destructive visual emphysema grades) for the COPD assessment test score is 0·21, for forced expiratory volume in 1 s (FEV1)/functional vital capacity is 0·25, for FEV1% of predicted is 0·23, for residual volume % of predicted is 0·24, for CT emphysema index is 0·35, for dark-field signal homogeneity within lungs is 0·38, for dark-field signal texture within lungs is 0·38, and for dark-field-based emphysema severity is 0·42. INTERPRETATION X-ray dark-field chest imaging allows the diagnosis of pulmonary emphysema in patients with COPD because this technique provides relevant information representing the structural condition of lung parenchyma. This technique might offer a low radiation dose alternative to CT in COPD and potentially other lung disorders. FUNDING European Research Council, Deutsche Forschungsgemeinschaft, Royal Philips, and Karlsruhe Nano Micro Facility.
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Affiliation(s)
- Konstantin Willer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Noichl
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Manuela Frank
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Theresa Urban
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Rafael Schick
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alex Gustschin
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Thomas Koehler
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Philips Research Hamburg, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC Hamburg, Hamburg, Germany
| | - Gregor S Zimmermann
- Department of Cardiology, Angiology, and Pneumology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, Paris, France
| | - Franz Pfeiffer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany; Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Grenier PA. Spatial Compactness of Emphysema at CT and Disease Severity. Radiology 2021; 301:710-711. [PMID: 34519582 DOI: 10.1148/radiol.2021211673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Philippe A Grenier
- From the Department of Clinical Research and Innovation, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France
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Chabi ML, Dana O, Kennel T, Gence-Breney A, Salvator H, Ballester MC, Vasse M, Brun AL, Mellot F, Grenier PA. Automated AI-Driven CT Quantification of Lung Disease Predicts Adverse Outcomes in Patients Hospitalized for COVID-19 Pneumonia. Diagnostics (Basel) 2021; 11:diagnostics11050878. [PMID: 34069115 PMCID: PMC8156322 DOI: 10.3390/diagnostics11050878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 05/09/2021] [Indexed: 12/16/2022] Open
Abstract
The purpose of our work was to assess the independent and incremental value of AI-derived quantitative determination of lung lesions extent on initial CT scan for the prediction of clinical deterioration or death in patients hospitalized with COVID-19 pneumonia. 323 consecutive patients (mean age 65 ± 15 years, 192 men), with laboratory-confirmed COVID-19 and an abnormal chest CT scan, were admitted to the hospital between March and December 2020. The extent of consolidation and all lung opacities were quantified on an initial CT scan using a 3D automatic AI-based software. The outcome was known for all these patients. 85 (26.3%) patients died or experienced clinical deterioration, defined as intensive care unit admission. In multivariate regression based on clinical, biological and CT parameters, the extent of all opacities, and extent of consolidation were independent predictors of adverse outcomes, as were diabetes, heart disease, C-reactive protein, and neutrophils/lymphocytes ratio. The association of CT-derived measures with clinical and biological parameters significantly improved the risk prediction (p = 0.049). Automated quantification of lung disease at CT in COVID-19 pneumonia is useful to predict clinical deterioration or in-hospital death. Its combination with clinical and biological data improves risk prediction.
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Affiliation(s)
- Marie Laure Chabi
- Department of Medical Imaging, Foch Hospital, 92150 Suresnes, France; (M.L.C.); (O.D.); (A.G.-B.); (A.L.B.); (F.M.)
| | - Ophélie Dana
- Department of Medical Imaging, Foch Hospital, 92150 Suresnes, France; (M.L.C.); (O.D.); (A.G.-B.); (A.L.B.); (F.M.)
| | - Titouan Kennel
- Department of Clinical Research and Innovation, Foch Hospital, 92150 Suresnes, France;
| | - Alexia Gence-Breney
- Department of Medical Imaging, Foch Hospital, 92150 Suresnes, France; (M.L.C.); (O.D.); (A.G.-B.); (A.L.B.); (F.M.)
| | - Hélène Salvator
- Department of Pneumology, Foch Hospital, UFR Santé Simone Veil UVSQ Paris-Saclay University, 92150 Suresnes, France;
| | | | - Marc Vasse
- Department of Clinical Biology, Foch Hospital, 92150 Suresnes, France;
- INSERM, UMRS 1176, Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Anne Laure Brun
- Department of Medical Imaging, Foch Hospital, 92150 Suresnes, France; (M.L.C.); (O.D.); (A.G.-B.); (A.L.B.); (F.M.)
| | - François Mellot
- Department of Medical Imaging, Foch Hospital, 92150 Suresnes, France; (M.L.C.); (O.D.); (A.G.-B.); (A.L.B.); (F.M.)
| | - Philippe A. Grenier
- Department of Clinical Research and Innovation, Foch Hospital, 92150 Suresnes, France;
- Correspondence:
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Brun AL, Chabi ML, Picard C, Mellot F, Grenier PA. Lung Transplantation: CT Assessment of Chronic Lung Allograft Dysfunction (CLAD). Diagnostics (Basel) 2021; 11:diagnostics11050817. [PMID: 33946544 PMCID: PMC8147203 DOI: 10.3390/diagnostics11050817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
Chronic lung allograft rejection remains one of the major causes of morbi-mortality after lung transplantation. The term Chronic Lung Allograft Dysfunction (CLAD) has been proposed to describe the different processes that lead to a significant and persistent deterioration in lung function without identifiable causes. The two main phenotypes of CLAD are Bronchiolitis Obliterans Syndrome (BOS) and Restrictive Allograft Syndrome (RAS), each of them characterized by particular functional and imaging features. These entities can be associated (mixed phenotype) or switched from one to the other. If CLAD remains a clinical diagnosis based on spirometry, computed tomography (CT) scan plays an important role in the diagnosis and follow-up of CLAD patients, to exclude identifiable causes of functional decline when CLAD is first suspected, to detect early abnormalities that can precede the diagnosis of CLAD (particularly RAS), to differentiate between the obstructive and restrictive phenotypes, and to detect exacerbations and evolution from one phenotype to the other. Recognition of early signs of rejection is crucial for better understanding of physiopathologic pathways and optimal management of patients.
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Affiliation(s)
- Anne-Laure Brun
- Radiology Department, Hôpital Foch, 92150 Suresnes, France; (M.-L.C.); (F.M.)
- Correspondence: (A.-L.B.); (P.A.G.)
| | - Marie-Laure Chabi
- Radiology Department, Hôpital Foch, 92150 Suresnes, France; (M.-L.C.); (F.M.)
| | - Clément Picard
- Respiratory Department, Hôpital Foch, 92150 Suresnes, France;
| | - François Mellot
- Radiology Department, Hôpital Foch, 92150 Suresnes, France; (M.-L.C.); (F.M.)
| | - Philippe A. Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, 92150 Suresnes, France
- Correspondence: (A.-L.B.); (P.A.G.)
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Affiliation(s)
- Philippe A Grenier
- From the Department of Radiology, Hôpital FOCH, 40 rue Worth, 92150 Suresnes, France
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Lowe KE, Regan EA, Anzueto A, Austin E, Austin JHM, Beaty TH, Benos PV, Benway CJ, Bhatt SP, Bleecker ER, Bodduluri S, Bon J, Boriek AM, Boueiz ARE, Bowler RP, Budoff M, Casaburi R, Castaldi PJ, Charbonnier JP, Cho MH, Comellas A, Conrad D, Costa Davis C, Criner GJ, Curran-Everett D, Curtis JL, DeMeo DL, Diaz AA, Dransfield MT, Dy JG, Fawzy A, Fleming M, Flenaugh EL, Foreman MG, Fortis S, Gebrekristos H, Grant S, Grenier PA, Gu T, Gupta A, Han MK, Hanania NA, Hansel NN, Hayden LP, Hersh CP, Hobbs BD, Hoffman EA, Hogg JC, Hokanson JE, Hoth KF, Hsiao A, Humphries S, Jacobs K, Jacobson FL, Kazerooni EA, Kim V, Kim WJ, Kinney GL, Koegler H, Lutz SM, Lynch DA, MacIntye Jr. NR, Make BJ, Marchetti N, Martinez FJ, Maselli DJ, Mathews AM, McCormack MC, McDonald MLN, McEvoy CE, Moll M, Molye SS, Murray S, Nath H, Newell Jr. JD, Occhipinti M, Paoletti M, Parekh T, Pistolesi M, Pratte KA, Putcha N, Ragland M, Reinhardt JM, Rennard SI, Rosiello RA, Ross JC, Rossiter HB, Ruczinski I, San Jose Estepar R, Sciurba FC, Sieren JC, Singh H, Soler X, Steiner RM, Strand MJ, Stringer WW, Tal-Singer R, Thomashow B, Vegas Sánchez-Ferrero G, Walsh JW, Wan ES, Washko GR, Michael Wells J, Wendt CH, Westney G, Wilson A, Wise RA, Yen A, Young K, Yun J, Silverman EK, Crapo JD. COPDGene ® 2019: Redefining the Diagnosis of Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2019; 6:384-399. [PMID: 31710793 PMCID: PMC7020846 DOI: 10.15326/jcopdf.6.5.2019.0149] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increased morbidity and mortality. There is a clear need for an expanded definition of COPD that is linked to physiologic, structural (computed tomography [CT]) and clinical evidence of disease. Using data from the COPD Genetic Epidemiology study (COPDGene®), we hypothesized that an integrated approach that includes environmental exposure, clinical symptoms, chest CT imaging and spirometry better defines disease and captures the likelihood of progression of respiratory obstruction and mortality. METHODS Four key disease characteristics - environmental exposure (cigarette smoking), clinical symptoms (dyspnea and/or chronic bronchitis), chest CT imaging abnormalities (emphysema, gas trapping and/or airway wall thickening), and abnormal spirometry - were evaluated in a group of 8784 current and former smokers who were participants in COPDGene® Phase 1. Using these 4 disease characteristics, 8 categories of participants were identified and evaluated for odds of spirometric disease progression (FEV1 > 350 ml loss over 5 years), and the hazard ratio for all-cause mortality was examined. RESULTS Using smokers without symptoms, CT imaging abnormalities or airflow obstruction as the reference population, individuals were classified as Possible COPD, Probable COPD and Definite COPD. Current Global initiative for obstructive Lung Disease (GOLD) criteria would diagnose 4062 (46%) of the 8784 study participants with COPD. The proposed COPDGene® 2019 diagnostic criteria would add an additional 3144 participants. Under the new criteria, 82% of the 8784 study participants would be diagnosed with Possible, Probable or Definite COPD. These COPD groups showed increased risk of disease progression and mortality. Mortality increased in patients as the number of their COPD characteristics increased, with a maximum hazard ratio for all cause-mortality of 5.18 (95% confidence interval [CI]: 4.15-6.48) in those with all 4 disease characteristics. CONCLUSIONS A substantial portion of smokers with respiratory symptoms and imaging abnormalities do not manifest spirometric obstruction as defined by population normals. These individuals are at significant risk of death and spirometric disease progression. We propose to redefine the diagnosis of COPD through an integrated approach using environmental exposure, clinical symptoms, CT imaging and spirometric criteria. These expanded criteria offer the potential to stimulate both current and future interventions that could slow or halt disease progression in patients before disability or irreversible lung structural changes develop.
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Affiliation(s)
- Katherine E. Lowe
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio
| | | | | | | | | | | | | | | | | | | | | | - Jessica Bon
- University of Pittsburgh, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | | | | | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, Torrance
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, Torrance
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Margaret Fleming
- Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | | | | | | | | | - Sarah Grant
- Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | | | - Tian Gu
- University of Michigan, Ann Arbor
| | - Abhya Gupta
- Boehringer Ingelheim, Biberach an der Riss, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Victor Kim
- Temple University, Philadelphia, Pennsylvania
| | - Woo Jin Kim
- Kangwon National University, Chuncheon, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Matthew Moll
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | - Stephen I. Rennard
- AstraZeneca, Cambridge, United Kingdom
- University of Nebraska Medical Center, Omaha
| | | | | | - Harry B. Rossiter
- Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, Torrance
- University of Leeds, Leeds, United Kingdom
| | | | | | | | | | | | - Xavier Soler
- University of California at San Diego
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | | | | | - William W. Stringer
- Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, Torrance
| | | | | | | | | | - Emily S. Wan
- Brigham and Women's Hospital, Boston, Massachusetts
- VA Boston Healthcare System, Jamaica Plain, Massachusetts
| | | | | | | | | | | | | | | | - Kendra Young
- University of Colorado Anschutz Medical Campus, Aurora
| | - Jeong Yun
- Brigham and Women's Hospital, Boston, Massachusetts
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Tominaga J, Bankier AA, Lee KS, Leung AN, Remy-Jardin M, Akira M, Arakawa H, Boiselle PM, Franquet T, Fujimoto K, Gevenois PA, Goo JM, Grenier PA, Hatabu H, Ichikado K, Im JG, Johkoh T, Lee KN, Lynch DA, Noma S, Song JW, Sakai F, Sugiyama Y. Inter-observer agreement in identifying traction bronchiectasis on computed tomography: its improvement with the use of the additional criteria for chronic fibrosing interstitial pneumonia. Jpn J Radiol 2019; 37:773-780. [DOI: 10.1007/s11604-019-00864-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/11/2019] [Indexed: 11/28/2022]
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18
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Grenier PA. Relationship between Interstitial Lung Abnormalities and Emphysema in Smokers with and Those without COPD. Radiology 2018; 288:610-611. [DOI: 10.1148/radiol.2018180270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Philippe A. Grenier
- From the Service de Radiologie Polyvalente et Oncologique, Sorbonne Université, Hôpital Pitié-Salpêtrière/APHP, 47/83 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France
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19
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Lynch DA, Moore CM, Wilson C, Nevrekar D, Jennermann T, Humphries SM, Austin JHM, Grenier PA, Kauczor HU, Han MK, Regan EA, Make BJ, Bowler RP, Beaty TH, Curran-Everett D, Hokanson JE, Curtis JL, Silverman EK, Crapo JD. CT-based Visual Classification of Emphysema: Association with Mortality in the COPDGene Study. Radiology 2018; 288:859-866. [PMID: 29762095 PMCID: PMC6122195 DOI: 10.1148/radiol.2018172294] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose To determine whether visually assessed patterns of emphysema at CT might provide a simple assessment of mortality risk among cigarette smokers. Materials and Methods Of the first 4000 cigarette smokers consecutively enrolled between 2007 and 2011 in this COPDGene study, 3171 had data available for both visual emphysema CT scores and survival. Each CT scan was retrospectively visually scored by two analysts using the Fleischner Society classification system. Severity of emphysema was also evaluated quantitatively by using percentage lung volume occupied by low-attenuation areas (voxels with attenuation of −950 HU or less) (LAA-950). Median duration of follow-up was 7.4 years. Regression analysis for the relationship between imaging patterns and survival was based on the Cox proportional hazards model, with adjustment for age, race, sex, height, weight, pack-years of cigarette smoking, current smoking status, educational level, LAA-950, and (in a second model) forced expiratory volume in 1 second (FEV1). Results Observer agreement in visual scoring was good (weighted κ values, 0.71–0.80). There were 519 deaths in the study cohort. Compared with subjects who did not have visible emphysema, mortality was greater in those with any grade of emphysema beyond trace (adjusted hazard ratios, 1.7, 2.5, 5.0, and 4.1, respectively, for mild centrilobular emphysema, moderate centrilobular emphysema, confluent emphysema, and advanced destructive emphysema, P < .001). This increased mortality generally persisted after adjusting for LAA-950. Conclusion The visual presence and severity of emphysema is associated with significantly increased mortality risk, independent of the quantitative severity of emphysema. Online supplemental material is available for this article.
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Affiliation(s)
- David A Lynch
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Camille M Moore
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Carla Wilson
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Dipti Nevrekar
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Theodore Jennermann
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Stephen M Humphries
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - John H M Austin
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Philippe A Grenier
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Hans-Ulrich Kauczor
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - MeiLan K Han
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Elizabeth A Regan
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Barry J Make
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Russell P Bowler
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Terri H Beaty
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Douglas Curran-Everett
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - John E Hokanson
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Jeffrey L Curtis
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Edwin K Silverman
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - James D Crapo
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | -
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
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Kahnert K, Jobst B, Biertz F, Biederer J, Watz H, Huber RM, Behr J, Grenier PA, Alter P, Vogelmeier CF, Kauczor HU, Jörres RA. Relationship of spirometric, body plethysmographic, and diffusing capacity parameters to emphysema scores derived from CT scans. Chron Respir Dis 2018; 16:1479972318775423. [PMID: 29742906 PMCID: PMC6302978 DOI: 10.1177/1479972318775423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Phenotyping of chronic obstructive pulmonary disease (COPD) with computed
tomography (CT) is used to distinguish between emphysema- and airway-dominated
type. The phenotype is reflected in correlations with lung function measures.
Among these, the relative value of body plethysmography has not been quantified.
We addressed this question using CT scans retrospectively collected from
clinical routine in a large COPD cohort. Three hundred and thirty five patients
with baseline data of the German COPD cohort COPD and
Systemic Consequences-Comorbidities
Network were included. CT scans were primarily evaluated
using a qualitative binary emphysema score. The binary score was positive for
emphysema in 52.5% of patients, and there were significant differences between
the positive/negative groups regarding forced expiratory volume in 1 second
(FEV1), FEV1/forced vital capacity (FVC),
intrathoracic gas volume (ITGV), residual volume (RV), specific airway
resistance (sRaw), transfer coefficient (KCO), transfer factor for carbon
monoxide (TLCO), age, pack-years, and body mass index (BMI). Stepwise
discriminant analyses revealed the combination of FEV1/FVC, RV, sRaw,
and KCO to be significantly related to the binary emphysema score. The
additional positive predictive value of body plethysmography, however, was only
slightly higher than that of the conventional combination of spirometry and
diffusing capacity, which if taken alone also achieved high predictive values,
in contrast to body plethysmography. The additional information on the presence
of CT-diagnosed emphysema as conferred by body plethysmography appeared to be
minor compared to the well-known combination of spirometry and CO diffusing
capacity.
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Affiliation(s)
- Kathrin Kahnert
- 1 Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Bertram Jobst
- 2 Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,3 Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany.,4 Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | - Frank Biertz
- 5 Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Jürgen Biederer
- 2 Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,3 Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany.,6 Radiologie Darmstadt, Gross-Gerau County Hospital, Gross-Gerau, Germany
| | - Henrik Watz
- 7 Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Rudolf M Huber
- 1 Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- 1 Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Philippe A Grenier
- 8 Department of Radiology, Pitie-Salpetriere Hospital, Sorbonne Université, Paris Cedex, France
| | - Peter Alter
- 9 Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Claus F Vogelmeier
- 9 Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Hans-Ulrich Kauczor
- 2 Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,3 Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany.,4 Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | - Rudolf A Jörres
- 10 Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich, Germany
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Haroche J, Papo M, Cohen-Aubart F, Charlotte F, Maksud P, Grenier PA, Cluzel P, Mathian A, Emile JF, Amoura Z. [Erdheim-Chester disease (ECD), an inflammatory myeloid neoplasia]. Presse Med 2016; 46:96-106. [PMID: 27234902 DOI: 10.1016/j.lpm.2016.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/11/2016] [Indexed: 01/21/2023] Open
Abstract
In a compatible clinico-radiological setting, the diagnosis of Erdheim-Chester disease (ECD) involves the analysis of histiocytes in tissue biopsies: they are typically foamy and CD68+ CD1a, whereas in Langerhans cell histiocytosis (LCH) they are CD68+ CD1a+. Overlap forms of histiocytoses are frequent. Technetium bone scintigraphy showing nearly constant tracer uptake by the long bones is highly suggestive of ECD and a 'hairy kidney' appearance on abdominal CT scan is observed in more than half ECD cases. CNS involvement is a strong prognostic factor and an independent predictor of death in cases of ECD. Optimal initial therapy for ECD appears to be administration of IFN-α (and/or pegylated IFN-α) and prolonged treatment significantly improves survival; however, tolerance may be poor. Best alternative therapies are anakinra, mainly effective for mild forms of the disease, infliximab, and sirolimus. Cases of ECD present with strong systemic immune activation, involving IFN-α, IL-1/IL1-RA, IL-6, IL-12, and MCP-1, consistent with the systemic immune Th-1-oriented disturbance associated with the disease. Between 57 and 75 % of ECD patients carry the BRAFV600E mutation, an activating mutation of the proto-oncogene BRAF. More than 50 cases harboring BRAF mutation and with severe multisystemic and refractory ECD (sometimes associated with LCH) have been treated worldwide with vemurafenib, a BRAF inhibitor that proved to be very beneficial. Other recurrent mutations of the MAPK (NRAS, MAP2K1) and PIK3 pathways (PIK3CA) have been found among ECD patients. As recurrent mutations in the MAPK pathway are found in ECD and LCH on a background of chronic inflammation, we believe that both conditions should be redefined as an inflammatory myeloid neoplasia.
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Affiliation(s)
- Julien Haroche
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France.
| | - Matthias Papo
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
| | - Fleur Cohen-Aubart
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
| | - Frédéric Charlotte
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, service d'anatomopathologie, Paris, France
| | - Philippe Maksud
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, service de médecine nucléaire, Paris, France
| | - Philippe A Grenier
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, département de radiologie, Paris, France
| | - Philippe Cluzel
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, département de radiologie, Paris, France
| | - Alexis Mathian
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
| | - Jean-François Emile
- Assistance publique-Hôpitaux de Paris, hôpital Ambroise-Paré, université Saint-Quentin-en-Yvelines, service d'anatomopathologie, Boulogne, France
| | - Zahir Amoura
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
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22
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Abstract
Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively.
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Affiliation(s)
- Philippe A Grenier
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
| | - Catalin I Fetita
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
| | - Pierre-Yves Brillet
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
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23
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Regan EA, Lynch DA, Curran-Everett D, Curtis JL, Austin JHM, Grenier PA, Kauczor HU, Bailey WC, DeMeo DL, Casaburi RH, Friedman P, Van Beek EJR, Hokanson JE, Bowler RP, Beaty TH, Washko GR, Han MK, Kim V, Kim SS, Yagihashi K, Washington L, McEvoy CE, Tanner C, Mannino DM, Make BJ, Silverman EK, Crapo JD. Clinical and Radiologic Disease in Smokers With Normal Spirometry. JAMA Intern Med 2015; 175:1539-49. [PMID: 26098755 PMCID: PMC4564354 DOI: 10.1001/jamainternmed.2015.2735] [Citation(s) in RCA: 320] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Airflow obstruction on spirometry is universally used to define chronic obstructive pulmonary disease (COPD), and current or former smokers without airflow obstruction may assume that they are disease free. OBJECTIVE To identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for COPD, for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0. DESIGN, SETTING, AND PARTICIPANTS Individuals from the Genetic Epidemiology of COPD (COPDGene) cross-sectional observational study completed spirometry, chest computed tomography (CT) scans, a 6-minute walk, and questionnaires. Participants were recruited from local communities at 21 sites across the United States. The GOLD 0 group (n = 4388) (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity >0.7 and FEV1 ≥80% predicted) from the COPDGene study was compared with a GOLD 1 group (n = 794), COPD groups (n = 3690), and a group of never smokers (n = 108). Recruitment began in January 2008 and ended in July 2011. MAIN OUTCOMES AND MEASURES Physical function impairments, respiratory symptoms, CT abnormalities, use of respiratory medications, and reduced respiratory-specific quality of life. RESULTS One or more respiratory-related impairments were found in 54.1% (2375 of 4388) of the GOLD 0 group. The GOLD 0 group had worse quality of life (mean [SD] St George's Respiratory Questionnaire total score, 17.0 [18.0] vs 3.8 [6.8] for the never smokers; P < .001) and a lower 6-minute walk distance, and 42.3% (127 of 300) of the GOLD 0 group had CT evidence of emphysema or airway thickening. The FEV1 percent predicted distribution and mean for the GOLD 0 group were lower but still within the normal range for the population. Current smoking was associated with more respiratory symptoms, but former smokers had greater emphysema and gas trapping. Advancing age was associated with smoking cessation and with more CT findings of disease. Individuals with respiratory impairments were more likely to use respiratory medications, and the use of these medications was associated with worse disease. CONCLUSIONS AND RELEVANCE Lung disease and impairments were common in smokers without spirometric COPD. Based on these results, we project that there are 35 million current and former smokers older than 55 years in the United States who may have unrecognized disease or impairment. The effect of chronic smoking on the lungs and the individual is substantially underestimated when using spirometry alone.
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Affiliation(s)
- Elizabeth A Regan
- National Jewish Health, Denver, Colorado2Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | | | | | - Jeffrey L Curtis
- Section of Pulmonary and Critical Care Medicine, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, An
| | - John H M Austin
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Philippe A Grenier
- Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - William C Bailey
- Translational Lung Research Center Heidelberg, German Center of Lung Research, University of Alabama, Birmingham
| | - Dawn L DeMeo
- Pulmonary and Critical Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard H Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles, Medical Center, Torrance
| | - Paul Friedman
- Department of Radiology, University of California, San Diego
| | | | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | | | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - George R Washko
- Pulmonary and Critical Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
| | - Victor Kim
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kunihiro Yagihashi
- Department of Radiology, St Marianna University School of Medicine, Sugao, Miyamaeku, Kawasaki, Kanagawa, Japan
| | - Lacey Washington
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | | | | | - David M Mannino
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington
| | | | - Edwin K Silverman
- Pulmonary and Critical Care, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Haroche J, Cohen-Aubart F, Charlotte F, Maksud P, Grenier PA, Cluzel P, Mathian A, Emile JF, Amoura Z. The histiocytosis Erdheim–Chester disease is an inflammatory myeloid neoplasm. Expert Rev Clin Immunol 2015. [DOI: 10.1586/1744666x.2015.1060857] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lynch DA, Austin JHM, Hogg JC, Grenier PA, Kauczor HU, Bankier AA, Barr RG, Colby TV, Galvin JR, Gevenois PA, Coxson HO, Hoffman EA, Newell JD, Pistolesi M, Silverman EK, Crapo JD. CT-Definable Subtypes of Chronic Obstructive Pulmonary Disease: A Statement of the Fleischner Society. Radiology 2015; 277:192-205. [PMID: 25961632 DOI: 10.1148/radiol.2015141579] [Citation(s) in RCA: 348] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this statement is to describe and define the phenotypic abnormalities that can be identified on visual and quantitative evaluation of computed tomographic (CT) images in subjects with chronic obstructive pulmonary disease (COPD), with the goal of contributing to a personalized approach to the treatment of patients with COPD. Quantitative CT is useful for identifying and sequentially evaluating the extent of emphysematous lung destruction, changes in airway walls, and expiratory air trapping. However, visual assessment of CT scans remains important to describe patterns of altered lung structure in COPD. The classification system proposed and illustrated in this article provides a structured approach to visual and quantitative assessment of COPD. Emphysema is classified as centrilobular (subclassified as trace, mild, moderate, confluent, and advanced destructive emphysema), panlobular, and paraseptal (subclassified as mild or substantial). Additional important visual features include airway wall thickening, inflammatory small airways disease, tracheal abnormalities, interstitial lung abnormalities, pulmonary arterial enlargement, and bronchiectasis.
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Affiliation(s)
- David A Lynch
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - John H M Austin
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - James C Hogg
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Philippe A Grenier
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Hans-Ulrich Kauczor
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Alexander A Bankier
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - R Graham Barr
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Thomas V Colby
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Jeffrey R Galvin
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Pierre Alain Gevenois
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Harvey O Coxson
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Eric A Hoffman
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - John D Newell
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Massimo Pistolesi
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - Edwin K Silverman
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
| | - James D Crapo
- From the Departments of Radiology (D.A.L.) and Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University, New York, NY (J.H.M.A.); Department of Pathology, University of British Columbia, Vancouver, BC, Canada (J.C.H.); Department of Radiology, Hôpital Pitié-Salpêtrière, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (H.U.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.V.C.); Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.); Department of Radiology, Hôpital Erasme, Brussels, Belgium (P.A.G.); Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada (H.C.); Department of Radiology, Division of Physiological Imaging, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa (E.A.H., J.D.N.); Respiratory Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (M.P.); and Channing Laboratory, Brigham and Women's Hospital, Boston, Mass (E.K.S.)
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Haroche J, Cohen-Aubart F, Emile JF, Maksud P, Drier A, Tolédano D, Barete S, Charlotte F, Cluzel P, Donadieu J, Benameur N, Grenier PA, Besnard S, Ory JP, Lifermann F, Idbaih A, Granel B, Graffin B, Hervier B, Arnaud L, Amoura Z. Reproducible and sustained efficacy of targeted therapy with vemurafenib in patients with BRAF(V600E)-mutated Erdheim-Chester disease. J Clin Oncol 2014; 33:411-8. [PMID: 25422482 DOI: 10.1200/jco.2014.57.1950] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Histiocytoses are rare disorders with heterogeneous prognosis. BRAF(V600E) mutations have been observed in half of patients with Langerhans cell histiocytosis (LCH) and in 50% to 100% of patients with Erdheim-Chester disease (ECD) patients. We recently reported short-term efficacy of a BRAF inhibitor (vemurafenib) in three patients with multisystemic ECD. PATIENTS AND METHODS Vemurafenib was given to eight patients with multisystemic ECD with CNS and/or cardiac involvement. All patients were refractory to first-line treatment and harbored a BRAF(V600E) mutation. Four patients also had LCH lesions. Positron emission tomography (PET) scan response at month 6 was used as the main evaluation criterion. Secondary evaluation criteria were comparison at baseline and at last visit of PET and of cardiovascular and cerebral infiltrations (computed tomography scan and magnetic resonance imaging [MRI]). RESULTS All patients were partial metabolic responders at 6 months of vemurafenib, and the median reduction in maximum standardized uptake value was 63.5% (range, 41.3% to 86.9%). Evaluation of cardiac and aortic infiltrations showed that seven patients had a partial response and one patient had stable disease according to surface measurements derived from RECIST criteria. The four patients with infratentorial CNS infiltration had an objective decrease of the lesions on MRI. All patients had an improvement of general symptoms and a persistent response to vemurafenib, with a median follow-up time of 10.5 months (range, 6 to 16 months). Skin adverse effects were frequent and severe. CONCLUSION Vemurafenib has an objective and sustained efficacy in BRAF(V600E)-mutated ECD as second-line therapy. In contrast to melanoma, no resistance has emerged to date after 6 to 16 months.
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Affiliation(s)
- Julien Haroche
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France.
| | - Fleur Cohen-Aubart
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Jean-François Emile
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Philippe Maksud
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Aurélie Drier
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Dan Tolédano
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Stéphane Barete
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Frédéric Charlotte
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Philippe Cluzel
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Jean Donadieu
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Neïla Benameur
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Philippe A Grenier
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Sophie Besnard
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Jean-Paul Ory
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - François Lifermann
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Ahmed Idbaih
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Brigitte Granel
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Bruno Graffin
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Baptiste Hervier
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Laurent Arnaud
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Zahir Amoura
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
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Fetita C, Ortner M, Brillet PY, Preteux F, Grenier PA. Volumetric quantification of airway wall in CT via collision-free active surface model: application to asthma assessment. IEEE Trans Med Imaging 2014; 33:1512-1526. [PMID: 24723624 DOI: 10.1109/tmi.2014.2316115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Emerging idea in asthma phenotyping, incorporating local morphometric information on the airway wall thickness would be able to better account for the process of airway remodeling as indicator of pathology or therapeutic impact. It is thus important that such information be provided uniformly along the airway tree, not on a sparse (cross-section) sampling basis. The volumetric segmentation of the airway wall from CT data is the issue addressed in this paper by exploiting a patient-specific surface active model. An original aspect taken into account in the proposed deformable model is the management of auto-collisions for this complex morphology. The analysis of several solutions ended up with the design of a motion vector field specific to the patient geometry to guide the deformation. The segmentation result, presented as two embedded inner/outer surfaces of the wall, allows the quantification of the tissue thickness based on a locally-defined measure sensitive to even small surface irregularities. The method is validated with respect to several ground truth simulations of pulmonary CT data with different airway geometries and acquisition protocols showing accuracy within the CT resolution range. Results from an ongoing clinical study on moderate and severe asthma are presented and discussed.
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Sverzellati N, Lynch DA, Pistolesi M, Kauczor HU, Grenier PA, Wilson C, Crapo JD. PHYSIOLOGIC AND QUANTITATIVE COMPUTED TOMOGRAPHY DIFFERENCES BETWEEN CENTRILOBULAR AND PANLOBULAR EMPHYSEMA IN COPD. Chronic Obstr Pulm Dis 2014; 1:125-132. [PMID: 26029738 DOI: 10.15326/jcopdf.1.1.2014.0114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The purpose was to define the differences between centrilobular (CLE) and panlobular emphysema (PLE) phenotypes in cigarette smokers with COPD by a combined qualitative-quantitative computed tomography (CT) analysis. METHODS Chest CT scans of 116 cigarette smokers were visually scored by 22 chest radiologists and 29 pulmonologists in a single setting for the predominant emphysema phenotype (e.g. CLE or PLE) and automatically quantified for emphysema{% low attenuation area (LAA) ≤ -950 HU - %LAAinsp-950, gas trapping extent and bronchial metrics{wall area % for segmental (%WAsegm) and subsegmental (%WAsubsegm) bronchi}. These quantitative CT indexes were compared and related to FEV1, FEV1/FVC, and smoking history as stratified for emphysema phenotype. RESULTS Although more frequent than CLE in GOLD stages 3 and 4 (p = 0.01), PLE was also scored in 38.2% of combined GOLD stages 1 and 2. PLE was positively associated with %LAAinsp-950 (OR = 1.18, 95% CI: 1.12 to 1.27, β coefficient = 0.17, p = <0.0001) and negatively associated with pack-years of smoking (OR = 0.97, 95% CI: 0.95 to 0.99, β coefficient = -0.02, p = 0.03). Both %WAsegm and %WAsubsegm were more strongly associated with FEV1% (R2 = 0.6 for both measures, p< 0.001) in CLE as compared to PLE (R2= 0.15, p = 0.02; R2 = 0.26, p< 0.001). CONCLUSIONS PLE likely represents a more advanced phase of emphysema, which may also occur in earlier COPD stages and show different interplay with airway disease as compared to CLE.
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Affiliation(s)
- Nicola Sverzellati
- Department of Surgery, Section of Diagnostic Imaging, University of Parma, Parma, Italy
| | - David A Lynch
- Division of Radiology, National Jewish Health, Denver, USA
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Internal Medicine, University of Florence, Italy
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Clinic Heidelberg, Germany
| | - P A Grenier
- Service de Radiologie Polyvalente, Diagnostique and Interventionelle, Hospital Pitie-Salpetriere, Paris, France
| | - C Wilson
- Division of Biostatistics and Bioinformatics, National Jewisj Health, Denver, Denver, USA
| | - J D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, USA
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Rossi B, Epelboin L, Jauréguiberry S, Lecso M, Roos-Weil D, Gabarre J, Grenier PA, Bricaire F, Caumes E. Melioidosis and hairy cell leukemia in 2 travelers returning from Thailand. Emerg Infect Dis 2013; 19:503-5. [PMID: 23750355 PMCID: PMC3647669 DOI: 10.3201/eid1903.121329] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ramon I, Mathian A, Bachelot A, Hervier B, Haroche J, Boutin-Le Thi Huong D, Costedoat-Chalumeau N, Wechsler B, Karmali R, Velkeniers B, Touraine P, Coussieu C, Bennani A, Renard-Penna R, Grenier PA, Wahl D, Piette JC, Amoura Z. Primary adrenal insufficiency due to bilateral adrenal hemorrhage-adrenal infarction in the antiphospholipid syndrome: long-term outcome of 16 patients. J Clin Endocrinol Metab 2013; 98:3179-89. [PMID: 23783099 DOI: 10.1210/jc.2012-4300] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Primary adrenal insufficiency due to bilateral adrenal hemorrhage-adrenal infarction is a rare and life-threatening manifestation of the antiphospholipid syndrome (APLS). Data on the long-term outcome are scarce. OBJECTIVE The aims of the present study were to analyze the long-term outcome related to APLS per se and to characterize the course of adrenal involvement. DESIGN We conducted a retrospective study of patients with bilateral adrenal hemorrhage-adrenal infarction secondary to APLS seen in the Department of Internal Medicine of Pitié-Salpêtrière Hospital in Paris (France) between January 1990 and July 2010. RESULTS Three patients died during the acute phase related to APLS manifestations. Sixteen patients (7 males; 9 females) were followed up during a median period of 3.5 years (range 0.3-28.1 years). Three episodes of recurrent thrombosis were noted. One patient died from cerebral hemorrhage 3 months after the onset of adrenal insufficiency. Repeated Synacthen tests showed complete absence of response in 8 of the 10 patients assessed; cortisol and aldosterone increased appropriately in one patient and to some extent in another one. Dehydroepiandrosterone levels and 24-hour urinary epinephrine levels remained abnormally low in all evaluated patients. Adrenal imaging performed more than 1 year after the initial event revealed completely atrophic glands in 9 of 11 patients. CONCLUSIONS This particular subset of APLS patients who survive the acute phase has a rather favorable long-term outcome. Although adrenal dysfunction is generally irreversible, adrenocortical function may, at least partially, recover in rare cases. In this view, measurement of early morning cortisol during follow-up is indicated to detect these patients.
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Affiliation(s)
- Isolde Ramon
- Service de Médecine Interne-Endocrinologie, Centre Hospitalier Universitaire Ambroise Paré, Université Libre de Bruxelles, B-7000 Mons, Belgium
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Janssens P, Arnaud L, Galicier L, Mathian A, Hie M, Sene D, Haroche J, Veyssier-Belot C, Huynh-Charlier I, Grenier PA, Piette JC, Amoura Z. Lupus enteritis: from clinical findings to therapeutic management. Orphanet J Rare Dis 2013; 8:67. [PMID: 23642042 PMCID: PMC3651279 DOI: 10.1186/1750-1172-8-67] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 04/28/2013] [Indexed: 12/15/2022] Open
Abstract
Lupus enteritis is a rare and poorly understood cause of abdominal pain in patients with systemic lupus erythematosus (SLE). In this study, we report a series of 7 new patients with this rare condition who were referred to French tertiary care centers and perform a systematic literature review of SLE cases fulfilling the revised ACR criteria, with evidence for small bowel involvement, excluding those with infectious enteritis. We describe the characteristics of 143 previously published and 7 new cases. Clinical symptoms mostly included abdominal pain (97%), vomiting (42%), diarrhea (32%) and fever (20%). Laboratory features mostly reflected lupus activity: low complement levels (88%), anemia (52%), leukocytopenia or lymphocytopenia (40%) and thrombocytopenia (21%). Median CRP level was 2.0 mg/dL (range 0–8.2 mg/dL). Proteinuria was present in 47% of cases. Imaging studies revealed bowel wall edema (95%), ascites (78%), the characteristic target sign (71%), mesenteric abnormalities (71%) and bowel dilatation (24%). Only 9 patients (6%) had histologically confirmed vasculitis. All patients received corticosteroids as a first-line therapy, with additional immunosuppressants administered either from the initial episode or only in case of relapse (recurrence rate: 25%). Seven percent developed intestinal necrosis or perforation, yielding a mortality rate of 2.7%. Altogether, lupus enteritis is a poorly known cause of abdominal pain in SLE patients, with distinct clinical and therapeutic features. The disease may evolve to intestinal necrosis and perforation if untreated. Adding with this an excellent steroid responsiveness, timely diagnosis becomes primordial for the adequate management of this rare entity.
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Affiliation(s)
- Peter Janssens
- Department of internal medicine, French reference centre for Systemic Lupus Erythematosus, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
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Brillet PY, Grenier PA, Fetita CI, Beigelman-Aubry C, Ould-Hmeidi Y, Ortner M, Nachbaur G, Adamek L, Chanez P. Relationship between the airway wall area and asthma control score in moderate persistent asthma. Eur Radiol 2013; 23:1594-602. [PMID: 23300036 DOI: 10.1007/s00330-012-2743-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/12/2012] [Accepted: 11/15/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the association between airway wall area and clinical asthma control, assessed by the Asthma Control Test (ACT). METHODS This cross-sectional study evaluated 96 adults for asthma control ["at least well controlled" (ACT ≥ 20; n = 52) or "not well controlled" (ACT < 20; n = 44) and airway dimensions: luminal area (LA), wall area (WA) and WA%], obtained using automated dedicated software measurements from volumetric CT images. Results were analysed for segmental bronchi, subsegmental bronchi in the right upper lobe and basilar segments, both uncorrected and corrected for body surface area (BSA). RESULTS For all bronchi corrected for BSA, there was no correlation between airway wall area and ACT score. There was a weak but statistically significant correlation between uncorrected WA and ACT score (r = -0.203; P = 0.047); WA values were numerically higher in the "not well-controlled" versus the "at least well-controlled asthma" subgroups. For sub-segmental bronchi, there was a correlation between the ACT score and both WA/BSA (r = -0.204; P = 0.047) and WA (r = -0.249; P = 0.014), and for upper lobe bronchi, between the ACT score and WA (r = -0.207; P = 0.044). CONCLUSION We demonstrated a correlation between subsegmental bronchial airway measurements and clinical control of asthma; this is probably a reflection of airway remodelling and structural changes in chronic poorly controlled asthma. KEY POINTS • Volumetric computed tomography offers new insights into bronchial morphology. • The relationship between current asthma control and airway wall abnormalities is assessed. • Some relationships between airway wall area and clinical control were demonstrated. • We observed less shape variation of bronchi in "not well-controlled" asthma patients.
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Affiliation(s)
- Pierre-Yves Brillet
- Université Paris 13, Sorbonne Paris Cité, UPRES EA 2363, Service de radiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.
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Luyt CE, Combes A, Becquemin MH, Beigelman-Aubry C, Hatem S, Brun AL, Zraik N, Carrat F, Grenier PA, Richard JCM, Mercat A, Brochard L, Brun-Buisson C, Chastre J. Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS. Chest 2013; 142:813-814. [PMID: 22948576 DOI: 10.1378/chest.12-0917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate. METHODS Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m²) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated. RESULTS At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%). CONCLUSIONS One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov
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Affiliation(s)
- Charles-Edouard Luyt
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France.
| | - Alain Combes
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Marie-Hélène Becquemin
- Service d'Explorations Fonctionnelles, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Catherine Beigelman-Aubry
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Stéphane Hatem
- Service d'explorations fonctionnelles cardio-vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Anne-Laure Brun
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Nizar Zraik
- Service d'Explorations Fonctionnelles, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Fabrice Carrat
- Service de Santé Publique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Unité Mixte de Recherche-S 707, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris 6-Pierre-et-Marie-Curie, Paris, France
| | - Philippe A Grenier
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | | | - Alain Mercat
- Service de Réanimation Médicale, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Laurent Brochard
- Intensive Care Unit, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Christian Brun-Buisson
- Service de Réanimation Médicale, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France
| | - Jean Chastre
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
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Luyt CE, Combes A, Becquemin MH, Beigelman-Aubry C, Hatem S, Brun AL, Zraik N, Carrat F, Grenier PA, Richard JCM, Mercat A, Brochard L, Brun-Buisson C, Chastre J. Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS. Chest 2013; 142:583-592. [PMID: 22948576 DOI: 10.1378/chest.11-2196] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate. METHODS Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m²) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated. RESULTS At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%). CONCLUSIONS One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov
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Affiliation(s)
- Charles-Edouard Luyt
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France.
| | - Alain Combes
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Marie-Hélène Becquemin
- Service d'Explorations Fonctionnelles, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Catherine Beigelman-Aubry
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Stéphane Hatem
- Service d'explorations fonctionnelles cardio-vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Anne-Laure Brun
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Nizar Zraik
- Service d'Explorations Fonctionnelles, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | - Fabrice Carrat
- Service de Santé Publique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Unité Mixte de Recherche-S 707, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris 6-Pierre-et-Marie-Curie, Paris, France
| | - Philippe A Grenier
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
| | | | - Alain Mercat
- Service de Réanimation Médicale, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Laurent Brochard
- Intensive Care Unit, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Christian Brun-Buisson
- Service de Réanimation Médicale, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France
| | - Jean Chastre
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France
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Guibal A, Bertin C, Egels S, Savier E, Grenier PA, Lucidarme O. Contrast-enhanced ultrasound (CEUS) follow-up after radiofrequency ablation or cryoablation of focal liver lesions: treated-area patterns and their changes over time. Eur Radiol 2012; 23:1392-400. [PMID: 23138387 DOI: 10.1007/s00330-012-2702-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 09/23/2012] [Accepted: 10/12/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe the early patterns of liver lesions successfully treated with radiofrequency ablation (RFA) or cryoablation (CA) and their changes over time. METHODS Twenty-two RFA-treated and 17 CA-treated patients underwent CEUS from week 1 to year 3 post-ablation. Patterns, margins and volumes of RF-induced and cryolesions were evaluated and compared over time. RESULTS After contrast enhancement, shortly after ablation, undefined margins with persistent enhancing small vessels penetrating >2 mm into the treated zone were significantly more frequent after CA (67 %) than RFA (22 %) (P < 0.02). During the arterial phase, a thin, enhancing marginal rim was seen during week 1 (T1) in around 28 % of RF lesions, while 75 % of cryolesions had thick enhancing rims (P < 0.02). The mean RF-induced lesion volume, maximum at T1 (44.1 ± 37.5 ml), shrank slowly over time, remaining clearly visible at 1 year (8.3 ± 7.4 ml). Cryolesions shrank faster (P = 0.009), from an average of 16.6 ± 7.1 ml at T1 to 1.7 ± 1.3 ml 1-year post-ablation. CONCLUSION RF-induced and cryolesions differ, particularly their margins and shrinkage rates. Knowing these differences allows avoidance of incomplete treatment or falsely diagnosed recurrence, especially after CA. KEY POINTS • Contrast-enhanced ultrasound (CEUS) provides new follow-up information following hepatic radiological inyervention. • CEUS provides good visualisation of vascular modifications after thermoablation. • RFA-induced lesions and cryoablated lesions differ. • Knowledge about RF and cryolesion patterns is essential for correct CEUS follow-up. • Cryolesions have thicker peripheral inflammatory reactions and shrink faster than RFA-induced lesions.
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Affiliation(s)
- Aymeric Guibal
- Radiology Department, Hôpital Pitié- Salpêtrière, AP-HP, Institut Universitaire de Cancérologie, University Pierre et Marie Curie, 47-83, Boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Claude-Desroches M, Bierry G, Touitou-Gottenberg D, Golmard JL, Grenier PA, Beigelman-Aubry C. Focal dependent pleural thickening at MDCT: pleural lesion or functional abnormality? Diagn Interv Imaging 2012; 93:360-4. [PMID: 22542210 DOI: 10.1016/j.diii.2012.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the characteristics of reversible focal pleural thickenings (PTs) mimicking real plaques, that firstly suggest asbestos exposure or pleural metastasis; to propose an imaging strategy and propose an explanation for their mechanism of formation. PATIENTS AND METHODS Retrospective review of data from 19 patients with PTs fitting the description of pleural plaques at chest computed tomography (CT) and presenting modifications (clearance or appearance) of at least one PT at an additional chest examination in prone position. RESULTS A total of 152 PTs were recorded on the first chest CT examinations with a range of two to 19 pleural opacities per patient. All PTs had a posterior distribution in the lower lobes. On the additional acquisitions, 144 PTs disappeared. Seventeen patients presented complete regression of PTs and two patients presented persistence of eight PTs. CONCLUSION Additional low dose acquisition in prone position should be performed in all patients presenting with focal PT in a dependent and basal location. This may allow to exclude a pleural plaque in case of asbestos exposure but also a pleural metastasis in oncologic patients. These reversible dependent PTs could be related to physiological focal accumulation of lymphatic fluid in subpleural area.
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Affiliation(s)
- M Claude-Desroches
- Department of Radiology, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47/83, boulevard de l'Hôpital, 75651 Paris, France
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Barr RG, Berkowitz EA, Bigazzi F, Bode F, Bon J, Bowler RP, Chiles C, Crapo JD, Criner GJ, Curtis JL, Dass C, Dirksen A, Dransfield MT, Edula G, Erikkson L, Friedlander A, Galperin-Aizenberg M, Gefter WB, Gierada DS, Grenier PA, Goldin J, Han MK, Hanania NA, Hansel NN, Jacobson FL, Kauczor HU, Kinnula VL, Lipson DA, Lynch DA, MacNee W, Make BJ, Mamary AJ, Mann H, Marchetti N, Mascalchi M, McLennan G, Murphy JR, Naidich D, Nath H, Newell JD, Pistolesi M, Regan EA, Reilly JJ, Sandhaus R, Schroeder JD, Sciurba F, Shaker S, Sharafkhaneh A, Silverman EK, Steiner RM, Strange C, Sverzellati N, Tashjian JH, van Beek EJR, Washington L, Washko GR, Westney G, Wood SA, Woodruff PG. A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation. COPD 2012; 9:151-9. [PMID: 22429093 DOI: 10.3109/15412555.2012.654923] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
UNLABELLED The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring. METHODS Volumetric inspiratory and expiratory CT scans of 294 subjects, including normal non-smokers, smokers without COPD, and smokers with GOLD Stage I-IV COPD, were scored at a multi-reader workshop using a standardized worksheet. There were 58 observers (33 pulmonologists, 25 radiologists); each scan was scored by 9-11 observers. Interobserver agreement was calculated using kappa statistic. Median score of visual observations was compared with QCT measurements. RESULTS Interobserver agreement was moderate for the presence or absence of emphysema and for the presence of panlobular emphysema; fair for the presence of centrilobular, paraseptal, and bullous emphysema subtypes and for the presence of bronchial wall thickening; and poor for gas trapping, centrilobular nodularity, mosaic attenuation, and bronchial dilation. Agreement was similar for radiologists and pulmonologists. The prevalence on CT readings of most abnormalities (e.g. emphysema, bronchial wall thickening, mosaic attenuation, expiratory gas trapping) increased significantly with greater COPD severity, while the prevalence of centrilobular nodularity decreased. Concordances between visual scoring and quantitative scoring of emphysema, gas trapping and airway wall thickening were 75%, 87% and 65%, respectively. CONCLUSIONS Despite substantial inter-observer variation, visual assessment of chest CT scans in cigarette smokers provides information regarding lung disease severity; visual scoring may be complementary to quantitative evaluation.
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Affiliation(s)
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- Division of Radiology, National Jewish Health, Denver, CO 80206, USA
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Arnaud L, Bach G, Zeitoun D, Drier A, Cluzel P, Grenier PA, Amoura Z, Haroche J. Whole-body MRI in Erdheim-Chester disease. Rheumatology (Oxford) 2012; 51:948-50. [PMID: 22378719 DOI: 10.1093/rheumatology/kes016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brillet PY, Attali V, Nachbaur G, Capderou A, Becquemin MH, Beigelman-Aubry C, Fetita CI, Similowski T, Zelter M, Grenier PA. Multidetector row computed tomography to assess changes in airways linked to asthma control. Respiration 2010; 81:461-8. [PMID: 21051856 DOI: 10.1159/000319580] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 07/15/2010] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In asthma, multidetector row computed tomography (MDCT) detects abnormalities that are related to disease severity, including increased bronchial wall thickness. However, whether these abnormalities could be related to asthma control has not been investigated yet. OBJECTIVE Our goal was to determine which changes in airways could be linked to disease control. METHODS Twelve patients with poor asthma control were included and received a salmeterol/fluticasone propionate combination daily for 12 weeks. Patients underwent clinical, functional, and MDCT examinations before and after the treatment period. MDCT examinations were performed using a low-dose protocol at a controlled lung volume (65% TLC). Bronchial lumen (LA) and wall areas (WA) were evaluated at a segmental and subsegmental level using BronCare software. Lung density was measured at the base of the lung. Baseline and end-of-treatment data were compared using the Wilcoxon signed-rank test. RESULTS After the 12-week treatment period, asthma control was achieved. Airflow obstruction and air trapping decreased as assessed by the changes in FEV(1) (p < 0.01) and expiratory reserve volume (p < 0.01). Conversely, LA and WA did not vary significantly. However, a median decrease in LA of >10% was observed in half of the patients with a wide intra- and intersubject response heterogeneity. This was concomitant with a decrease in lung density (p < 0.02 in the anteroinferior areas). CONCLUSIONS MDCT is insensitive for demonstrating any decrease in bronchial wall thickness. This is mainly due to changes in bronchial caliber which may be linked to modifications of the elastic properties of the bronchopulmonary system under treatment.
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Affiliation(s)
- Pierre-Y Brillet
- UPRES EA 2363, Service de radiologie, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris 13, Bobigny, France. pierre-yves.brillet @ avc.aphp.fr
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Arnaud L, Pierre I, Beigelman-Aubry C, Capron F, Brun AL, Rigolet A, Girerd X, Weber N, Piette JC, Grenier PA, Amoura Z, Haroche J. Pulmonary involvement in Erdheim-Chester disease: A single-center study of thirty-four patients and a review of the literature. ACTA ACUST UNITED AC 2010; 62:3504-12. [DOI: 10.1002/art.27672] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Arnaud L, Malek Z, Archambaud F, Kas A, Toledano D, Drier A, Zeitoun D, Cluzel P, Grenier PA, Chiras J, Piette JC, Amoura Z, Haroche J. 18F-fluorodeoxyglucose-positron emission tomography scanning is more useful in followup than in the initial assessment of patients with Erdheim-Chester disease. ACTA ACUST UNITED AC 2009; 60:3128-38. [DOI: 10.1002/art.24848] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Grenier PA, Beigelman-Aubry C, Fetita CI, Brillet PY. CT imaging of chronic obstructive pulmonary disease: role in phenotyping and interventions. ACTA ACUST UNITED AC 2009; 3:689-703. [DOI: 10.1517/17530050903117264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Haroche J, Cluzel P, Toledano D, Montalescot G, Touitou D, Grenier PA, Piette JC, Amoura Z. Images in cardiovascular medicine. Cardiac involvement in Erdheim-Chester disease: magnetic resonance and computed tomographic scan imaging in a monocentric series of 37 patients. Circulation 2009; 119:e597-8. [PMID: 19564564 DOI: 10.1161/circulationaha.108.825075] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julien Haroche
- Department of Internal Medicine,Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, Paris, France.
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Brillet PY, Fetita CI, Capderou A, Mitrea M, Dreuil S, Simon JM, Prêteux F, Grenier PA. Variability of bronchial measurements obtained by sequential CT using two computer-based methods. Eur Radiol 2009; 19:1139-47. [PMID: 19137314 DOI: 10.1007/s00330-008-1247-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 10/16/2008] [Accepted: 10/19/2008] [Indexed: 01/23/2023]
Abstract
This study aimed to evaluate the variability of lumen (LA) and wall area (WA) measurements obtained on two successive MDCT acquisitions using energy-driven contour estimation (EDCE) and full width at half maximum (FWHM) approaches. Both methods were applied to a database of segmental and subsegmental bronchi with LA > 4 mm(2) containing 42 bronchial segments of 10 successive slices that best matched on each acquisition. For both methods, the 95% confidence interval between repeated MDCT was between -1.59 and 1.5 mm(2) for LA, and -3.31 and 2.96 mm(2) for WA. The values of the coefficient of measurement variation (CV(10), i.e., percentage ratio of the standard deviation obtained from the 10 successive slices to their mean value) were strongly correlated between repeated MDCT data acquisitions (r > 0.72; p < 0.0001). Compared with FWHM, LA values obtained using EDCE were higher for LA < 15 mm(2), whereas WA values were lower for bronchi with WA < 13 mm(2); no systematic EDCE underestimation or overestimation was observed for thicker-walled bronchi. In conclusion, variability between CT examinations and assessment techniques may impair measurements. Therefore, new parameters such as CV(10) need to be investigated to study bronchial remodeling. Finally, EDCE and FWHM are not interchangeable in longitudinal studies.
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Brillet PY, Fetita CI, Saragaglia A, Brun AL, Beigelman-Aubry C, Prêteux F, Grenier PA. Investigation of airways using MDCT for visual and quantitative assessment in COPD patients. Int J Chron Obstruct Pulmon Dis 2008; 3:97-107. [PMID: 18488432 PMCID: PMC2528203 DOI: 10.2147/copd.s2302] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Multidetector computed tomography (MDCT) acquisition during a single breath hold using thin collimation provides high resolution volumetric data set permitting multiplanar and three dimensional reconstruction of the proximal airways. In chronic obstructive pulmonary disease (COPD) patients, this technique provides an accurate assessment of bronchial wall thickening, tracheobronchial deformation, outpouchings reflecting dilatation of the submucous glands, tracheobronchomalacia, and expiratory air trapping. New software developed to segment adequately the lumen and walls of the airways on MDCT scans allows quantitative assessment of the airway dimensions which has shown to be reliable in clinical practice. This technique can become important in longitudinal studies of the pathogenesis of COPD, and in the assessment of therapeutic interventions.
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Affiliation(s)
- Pierre-Yves Brillet
- Department of Radiology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Université Leonard deVinci-Paris Nord, EA 2361, Bobigny, France
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Beigelman-Aubry C, Raffy P, Yang W, Castellino RA, Grenier PA. Computer-aided detection of solid lung nodules on follow-up MDCT screening: evaluation of detection, tracking, and reading time. AJR Am J Roentgenol 2007; 189:948-55. [PMID: 17885070 DOI: 10.2214/ajr.07.2302] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this article is to assess detection, tracking, and reading time of solid lung nodules > or = 4 mm on pairs of MDCT chest screening examinations using a computer-aided detection (CAD) system. MATERIALS AND METHODS Of 54 pairs of low-dose MDCT chest examinations (1.25-mm collimation), two chest radiologists in consensus established that 25 examinations contained 52 nodules > or = 4 mm. All paired examinations were interpreted on the CAD workstation--first without and then with CAD input--for the detection and tracking of lung nodules. A subset of 33 examination pairs was later read on the clinical workstation used in daily practice, and the results were compared for reading time with those on the CAD workstation. RESULTS After CAD input, the sensitivity for nodule detection increased statistically significantly for both readers (9.6% and 23%; p < or = 0.025). One cancer initially missed by one radiologist was correctly identified with CAD input. The overall reading time on the CAD workstation and clinical workstation was comparable for both radiologists. On average, readers spent 4-5 minutes per case to read the paired examinations on the CAD workstation and 6-8 seconds per CAD mark. The CAD system successfully matched 91.3% of nodules detected in both examinations. The overall rate of available CAD growth assessment was 54.9% of all nodule pairs. CONCLUSION In the context of temporal comparison of MDCT screening examinations, the sensitivity of radiologists for detecting lung nodules > or = 4 mm increased significantly (p < or = 0.025) with CAD input without compromising reading time.
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Affiliation(s)
- Catherine Beigelman-Aubry
- Department of Radiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie, Paris VI, 47-83 bd de L'Hôpital, 75651 Paris, Cedex 13, France
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Blanchon T, Bréchot JM, Grenier PA, Ferretti GR, Lemarié E, Milleron B, Chagué D, Laurent F, Martinet Y, Beigelman-Aubry C, Blanchon F, Revel MP, Friard S, Rémy-Jardin M, Vasile M, Santelmo N, Lecalier A, Lefébure P, Moro-Sibilot D, Breton JL, Carette MF, Brambilla C, Fournel F, Kieffer A, Frija G, Flahault A. Baseline results of the Depiscan study: A French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR). Lung Cancer 2007; 58:50-8. [PMID: 17624475 DOI: 10.1016/j.lungcan.2007.05.009] [Citation(s) in RCA: 194] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 05/11/2007] [Accepted: 05/17/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lung cancer has the highest mortality-rate per cancer, with an overall 5-year survival <15%. Several non-randomized studies pointed out the high sensitivity of low dose computed tomography (LDCT) to detect early stage lung cancer. In France, Depiscan, a pilot RCT of LDCT versus chest X-ray (CXR), started on October 2002 to determine the feasibility of enrollment by general practitioners (GPs), investigations and diagnostic procedures by university hospital radiologists and multidisciplinary teams, data management by centralized clinical research assistants, and anticipate the future management of a large national trial. METHODS GPs and occupational physicians (OPs) selected and enrolled 1000 subjects in 1 year. Eligible subjects were asymptomatic males or females aged 50-75 years with a current or former cigarette smoking history of >/=15 cigarettes per day for at least 20 years (former smokers having quit <15 years prior to enrollment). Based to randomization, annual LDCT or CXR screenings were planned at baseline and annually for 2 years. RESULTS Between October 2002 and December 2004, 765 subjects were enrolled by 89 out of the 232 participating GPs and OPs. Complete clinical and imaging baseline data were available for 621 individuals out of the 765 enrolled, due to 144 noncompliant subjects who withdrew their consent. At least one nodule was detected in 152 out of 336 subjects (45.2%) in the LDCT screening, versus 21 out of 285 subjects (7.4%) in the CXR screening arm. Eight lung cancers were detected in the LDCT arm and one in the CXR arm. DISCUSSION This pilot trial allows estimating that non-calcified nodules are 10 [6.36-17.07] times more often detected from LDCT than from CXR. However enrollment by GPs was more difficult than expected with 41% active investigators and a high rate (19%) of noncompliant patients. This experience speaks to the need for a high level of GPs formation and a large, coordinated clinical research team in such a trial. TRIAL REGISTRATION NUMBER 02526.
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Brochu B, Beigelman-Aubry C, Goldmard JL, Raffy P, Grenier PA, Lucidarme O. [Computer-aided detection of lung nodules on thin collimation MDCT: impact on radiologists' performance]. ACTA ACUST UNITED AC 2007; 88:573-8. [PMID: 17464256 DOI: 10.1016/s0221-0363(07)89857-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Evaluate the improvement in detecting lung nodules when using multidetector CT (MDCT) computer-assisted diagnosis (CAD). MATERIAL AND METHODS Three radiologists (R1, R2, R3) with different levels of experience independently interpreted 30 MDCT examinations of the thorax taken for screening purposes, first without and then with CAD. The diagnosis was established by two of the three radiologists interpreting the images together, assisted by the CAD. RESULTS The consensus reading identified 133 nodules, 61 (46%) of which were 4 mm or larger. The sensitivity values in the detection of nodules before and after using the CAD were 54% and 80% (R1), 38% and 71% (R2), and 70% and 88% (R3), respectively. When considering only the nodules that were 4 mm or larger, the sensitivity values varied before and after using the CAD, from 62% to 95% (R1), from 41% to 84% (R2), and from 74% to 92% (R3). By combining two by two the three radiologists' results obtained without the CAD, the sensitivity values were 65%, 83%, and 77%, respectively, for all the nodules, and 70%, 85%, and 77% for the nodules that were 4 mm or larger. The CAD induced a total of 105 false-positive results, with a mean of 3.5 per examination. CONCLUSION The lung nodules missed by the radiologist can be detected if the CAD is used as a second reader. The CAD can be at least as beneficial as the use of a second independent reader.
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Affiliation(s)
- B Brochu
- Service de Radiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris Cedex 13, France
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